Pancreatic cancer has taken the lives of numerous celebrities and well-known people,
such as Steve Jobs, Jerry Springer, Patrick Swayze, the astronaut Sally Ride, opera
singer Luciano Pavarotti, and Aretha Franklin. Pancreatic cancer leads to the deaths of
approximately 50,550 Americans every year. The signs and symptoms of pancreatic
cancer may go unnoticed until the disease is in its later stages, which is why the five-
year survival rate of pancreatic cancer is 12%. When pancreatic cancer is diagnosed, it
is typically staged using the TNM (tumor, node, metastasis) staging system in
combination with a numerical staging system (stages 0 to IV).
The TNM staging system considers:
- The size of the tumor and if the tumor has spread from the pancreas to nearby blood vessels.
- Whether the cancer has spread to nearby lymph nodes. If yes, how many of the nearby lymph nodes have cancer?
- Whether the cancer has metastasized (spread) to other parts of the body. If yes, has it spread to nearby or distant organs?
The numerical stages of pancreatic cancer:
Stage 0: Also called carcinoma in situ, this stage refers to abnormal cells that are found
in the lining of the pancreas. These cells have not spread to nearby tissues or organs.
Stage I: The tumor is confined to the pancreas and has not spread to nearby lymph
nodes or other organs.
Stage II: The tumor has grown beyond the pancreas and may have invaded nearby
organs or tissues, but it has not spread to distant sites.
Stage III: The tumor has spread to nearby lymph nodes and may have invaded nearby
blood vessels or nerves.
Stage IV: The cancer has spread to distant organs or tissues.
Application of the TNM and Numerical Staging Systems to Pancreatic Cancer:
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ, also known as pancreatic intraepithelial neoplasia (PanIN)
T1: Tumor confined to the pancreas, 2 cm or smaller
T2: Tumor confined to the pancreas, larger than 2 cm but not larger than 4 cm
T3: Tumor extends beyond the pancreas but does not involve the celiac axis or
superior mesenteric artery (SMA)
T4: Tumor involves the celiac axis or SMA
NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Regional lymph node metastasis
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis present
Stage 0: Tis, N0, M0
Stage IA: T1, N0, M0
Stage IB: T2, N0, M0
Stage IIA: T3, N0, M0
Stage IIB: T1-T3, N1, M0 or T4, N0-N1, M0
Stage III: T1-T4, N2, M0
Stage IV: Any T, Any N, M1
The TNM staging system combined with the numerical staging system is just one tool
used to guide surgical and treatment decisions for patients with pancreatic cancer. For
treatment purposes, doctors often classify patients’ pancreatic cancer into four stages
based on how advanced the disease is: resectable (localized), borderline resectable,
locally advanced, and metastatic.
- Resectable (Localized) Pancreatic Cancer: The tumor is confined to the pancreas
and has not spread to other organs or structures nearby. Surgery is typically the
first line of treatment. Chemotherapy or radiation therapy may be used before or
after surgery to help prevent the cancer from recurring.
- Borderline Resectable Pancreatic Cancer: The tumor has grown into nearby
structures or blood vessels but has not yet spread to other organs. Surgery may
be an option, but it may require a more complex surgical approach.
Chemotherapy or radiation therapy may be used before or after surgery to help
shrink the tumor.
- Locally Advanced Pancreatic Cancer: The tumor has grown into nearby
structures or blood vessels and is considered inoperable. Chemotherapy and
radiation therapy are the main treatment options for this stage of pancreatic
- Metastatic Pancreatic Cancer: In this stage, which is the most advanced, the
cancer has spread to distant organs. Treatment options for metastatic
pancreatic cancer focus on controlling symptoms and improving quality of life,
rather than curing the cancer. Chemotherapy is the main treatment option for this
Overall, the exact classification of pancreatic cancer into stages depends on numerous
factors, including the location and size of the tumor, whether it has spread to nearby
lymph nodes or distant organs, and a patient’s overall health. Pancreatic cancer is often
diagnosed at an advanced stage because it tends to be asymptomatic in its early
stages. This makes treatment more difficult, which is why early detection and screening
are crucial for improving outcomes.